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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 174-178    DOI: 10.31083/j.ceog.2020.02.5014
Original Research Previous articles | Next articles
Clinical analysis of atrial fibrillation in pregnant women
H. F. Zhang1, J. Zhang1, D. Yang1, *(), S. N. Li2
1Obstetrics and Gynecology Medical Centre of Severe Cardiovascular Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
2Department of Cardiology, Beijing Anzhen Hospital, Beijing 100029, P.R. China
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Abstract  Objective: To analyze the clinical characteristics and risk factors for the major adverse cardiovascular events (MACEs) of atrial fibrillation (AF) in pregnant women. Materials and Methods: A retrospective analysis was performed on 35 pregnant women with AF, who were treated at Beijing Anzhen Hospital, Capital Medical University, from January 2004 to May 2017. All pregnancies were recorded. Chi-squared test analysis was performed to determine the correlation between clinical factors and MACEs. Results: There were 11 cases of MACEs (31.4%), including 10 cases of heart failure (HF) and 1 case of cerebral infarction. We found 7 clinical factors with a clear correlation with the occurrence of MACEs during pregnancy: a medical history of heart operation (P = 0.0011) and AF before pregnancy (P = 0.0281), New York Heart Association (NYHA) class (P < 0.0001), a left ventricular ejection fraction (LVEF) ≤ 50% (P = 0.0055), and a delivery time < 37 weeks (P = 0.0037). The AF subtype and delivery mode have no correlation with MACEs. Conclusion: AF in pregnant women is dangerous for pregnancy and delivery, multi-disciplinary management of obstetricians, cardiologists, and neonatologists are crucial for these patients throughout pregnancy.
Key words:  Atrial fibrillation      Pregnancy      Clinical factors      MACEs     
Published:  15 April 2020     
*Corresponding Author(s):  D. Yang     E-mail:  cndongyang@126.com

Cite this article: 

H. F. Zhang, J. Zhang, D. Yang, S. N. Li. Clinical analysis of atrial fibrillation in pregnant women. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 174-178.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.02.5014     OR     https://ceog.imrpress.com/EN/Y2020/V47/I2/174

Table 1  — Classification of pregnant women with AF.
Subtypes of AF N (%)
I: Lone atrial fibrillation (LAF) 8 (22.8%)
II: Secondary to structural heart disease 24 (68.6%)
AF in CHD 2
AF in RHD 19
AF in Cardiomyopathy 3
III: No structural heart disease 3 (8.6%)
Hypertension atrial fibrillation 1
Hyperthyroid atrial fibrillation 1
Hypothyroid atrial fibrillation 1
Table 2  — Maternal baseline characteristics.
Characteristics N (%)
Age (years)
<35 29 (82.9%)
≥35 6 (17.1%)
Multipara
Yes 6 (17.1%)
No 29 (82.9%)
NYHA class
I-II 24 (68.6%)
III-IV 11 (31.4%)
LVEF
≤40% 9 (25.7%)
41-54% 5 (14.3%)
≥55% 21 (60.0%)
AF medical history
Yes 22 (62.9%)
No 13 (37.1%)
Symptom
Symptomatic AF 24 (68.6%)
Asymptomatic AF 11 (31.4%)
Medical history
AF 22 (62.9%)
Heart failure 0 (0%)
Hypertension 1 (2.9%)
Cerebral infarction 1 (2.9%)
Operation for heart disease pre-pregnancy 13 (37.1%)
Table 3  — Pregnancy outcomes of pregnant women with AF.
Characteristics N (%)
Delivery week
≤28 3 (8.6%)
28-32 (32) 3 (8.6%)
32-36 (36) 10 (28.6%)
≥37 19 (54.3%)
Delivery mode
Vaginal 7 (20.0%)
Cesarean section 28 (80.0%)
Obstetrical complication
PROM 2 (5.7%)
Preeclampsia 4 (11.4%)
GDM 2 (5.7%)
Postpartum hemorrhage 1 (2.9%)
Neonatal outcome
Birth time
Full-term 19 (54.3%)
Premature 13 (37.1%)
Medical induced abortion 3 (8.6%)
Birth-weight
Normal 20 (57.1%)
Low 12 (34.3%)
NA 3 (8.6%)
Neonatal asphyxia
Yes 5 (14.3%)
No 27 (77.1%)
Table 4  — Characteristics of patients who have experienced MACEs in this study.
Structural-heart disease MACEs NYHA class LVEF (%) AF Heart operation before pregnancy
RHD HF I-II 55 Y Y
Cardiomyopathy (PPCM) HF III-IV 20 N N
RHD HF III-IV 48 N N
RHD HF III-IV 40 Y N
RHD HF III-IV 44 N N
RHD HF III-IV 40 N N
RHD HF III-IV 33 N N
Cardiomyopathy (DCM) HF III-IV 40 N N
Cardiomyopathy (RCM) Cerebral infarction III-IV 55 N N
RHD HF III-IV 50 Y N
No HF I-II 50 Y NA
Table 5  — Comparison of clinical factors between patients with and without Major Adverse Cardiovascular Events (MACEs) during pregnancy and postpartum period.
Clinical factors MACEs (n = 11) No MACEs (n = 26) P -value (Chi-square)
Subtype 0.1443 (3.8723)
I 1 (12.5%) 7 (87.5%)
II 10 (41.67%) 14 (58.33%)
III 0 3
Medical history of heart operation 0.0011 (10.5926)
After Heart operation 1 (7.69%) 12 (92.31%)
No Heart operation 9 (81.82%) 2 (18.18%)
NA 1 10
NYHA class
I-II

2 (8.33%)

22 (91.6%)
< 0.0001 (18.9001)
III-IV 9 (81.82%) 2 (18.18%)
Medical history of AF 0.0281 (4.8228)
Yes 4 (18.18%) 18 (81.82%)
No 7 (53.85%) 6 (46.15%)
LVEF% 0.0055 (7.7215)
50
>50
7 (63.64%)
4 (16.67%)
4 (36.36%)
20 (83.33%)
Delivery time 0.0037 (8.4260)
<37 weeks 9 (56.25%) 7 (43.75%)
37week 2 (10.53%) 17 (89.47%)
Delivery mode 0.1218* (2.3946)
Vaginal 0 7 (100%)
Cesarean section 11 (39.29%) 17 (60.71%)
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